Surgeons need to rethink strategies for managing refractory gastroesophageal reflux disease (rGERD).

• Prolonged disease duration and anxiety are new high-risk factors for rGERD.
• Moderate exercise (90+ minutes/week) may help protect against rGERD.

Adjusting treatments, including dose modifications or switching to vonoprazan, is crucial for rGERD patients.

• Consider lifestyle interventions like anti-anxiety therapy and supervised exercise as part of a comprehensive management approach.